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Pearls from the literature


Melanocyte-keratinocyte transplantation procedure: A few insights (Free article)
Sanjeev V Mulekar
National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia; Mulekar Clinic, Mumbai, Maharashtra, India, 

IJD Year : 2016  |  Volume : 82  |  Issue : 1  |  Page : 13-15



Dermatology. 2016 Feb 3.

Successful Treatment of Segmental Vitiligo in Children with the Combination of 1-mm Minigrafts and Phototherapy.

Tsuchiyama K1, Watabe A, Sadayasu A, Onodera N, Kimura Y, Aiba S.


13 patients with segmental vitiligo were treated with 1mm punch grafts followed by treatment with Excimer laser (11 patients) and narow band UVB (2 patients). The treatment was highly successful in this group of under 16 years age.




J Cutan Med Surg. 2011 Sep-Oct;15(5):280-4.

Worsening of Vitiligo and Onset of New Psoriasiform Dermatitis following Treatment with Infliximab.

Alghamdi KM, Khurrum H, Rikabi A.


This case report shows that infliximab given for vitiligo did not improve the disorder and that the vitiligo actually progressed. Moreover, psoriasiform lesions developed after this therapy.




Br J Dermatol. 2011 Nov 4. doi: 10.1111/j.1365-2133.2011.10723.x. [Epub ahead of print]

Combination treatment of 10,600 nm ablative carbon dioxide fractional laser and narrow band UVB in refractory non-segmental vitiligo: A prospective, randomized half-body comparative study.

Shin J, Lee JS, Hann SK, Oh SH.


Korea Institute of Vitiligo Research & Drs. Woo and Hann's Skin CenterDepartment of Dermatology & Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.


This study suggests that fractional CO2 laser therapy followed by NB-UVB could be used effectively and safely as an alternative modality for the treatment of refractory vitiligo.





Photomed Laser Surg. 2011 Nov 4

Vitiligo Treatment with Monochromatic Excimer Light (MEL) and Tacrolimus: Results of an Open Randomized Controlled Study.

Nisticò S, Chiricozzi A, Saraceno R, Schipani C, Chimenti S.


Department of Dermatology, University of Rome Tor Vergata , Rome, Italy .


The combination treatment of 0.1% tacrolimus ointment plus 308-nm MEL and 308-nm MEL monotherapy are effective, safe, and well tolerated for the treatment of vitiligo compared to treatment with vitamin E. Furthermore, this study suggests that an association with topical immunomodulators could enhance the clinical response in vitiligo, especially in more resistant anatomical sites.




Br J Dermatol. 2011 May;164(5):1004-9. doi: 10.1111/j.1365-2133.2010.10202.x. Epub 2011 Apr 5.

Classification of segmental vitiligo on the face: clues for prognosis.

Kim DY, Oh SH, Hann SK.


Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, 134 Sinchon-dong, Seodaemun-gu, Seoul 120-752, Korea *Korea Institute of Vitiligo Research, Drs Woo and Hann's Skin Center, 15-3 Garwol-dong, Yongsan-gu, Seoul 140-801, Korea.


257 patients with segmental vitiligo were observed for one year.  6 patterns of segmental were recognised.  Recognition of these patterns may be valuable in determining prognosis and the path of lesion spread.





BMC Complement Altern Med. 2011 Mar 15;11:21.

Ginkgo biloba for the treatment of vitilgo vulgaris: an open label pilot clinical trial.

Szczurko O, Shear N, Taddio A, Boon H.


Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, 130 Dundas St East, Suite 305, Mississauga, ON L5A 3V8, Canada.


12 patients were treated with 60mg Ginkgo biloba twice a day for 12 weeks.  The progression of vitiligo stopped in all patients vitiligo lesions improved by 15%.





J Eur Acad Dermatol Venereol. 2011 Apr 6. doi: 10.1111/j.1468-3083.2011.04002.x. [Epub ahead of print]

Treatment of vitiligo with narrowband-UVB (TL01) combined with tacrolimus ointment (0.1%) vs. placebo ointment, a randomized right/left double-blind comparative study.

Nordal E, Guleng G, Rönnevig J.


Department of Dermatology, Oslo University Hospital, Oslo, Norway Nordbergklinikken, Oslo, Norway.


In a study of 40 patients, tacrolimus was applied to 1/2 the body and placebo on the other 1/2.  The whole body was treated with narrow band UVB twice or thrice weekly for 3 months.  The mean reduction of the target lesion on the tacrolimus side was 41% and on the placebo side 29%.  Narrow band UVB and tacrolimus 0,1% is more effective than NB UVB alone.





J Cutan Aesthet Surg. 2011 Jan;4(1):41-3.

Single-hair follicular unit transplant for stable vitiligo.

Kumaresan M.


Department of Dermatology, PSG Hospitals, Coimbatore, India.


Single hair transplant was performed on the upper lip of a 30 year old male.  Repigmentation was seen in 4 weeks and was complete in 8 weeks. There was no recurrence at 6 months.





J Drugs Dermatol. 2011 May 1;10(5):507-10.

Topical tacrolimus is more effective for treatment of vitiligo in patients of skin of color.

Silverberg JI, Silverberg NB.


St. Luke's-Roosevelt Hospital and Beth Israel Medical Center, New York, NY.


Topical tacrolimus was effective in all skin typeswith superior results in patients with type 3 and 4 skin. Repigmentation of the head and neck was superior in all skin types compared to body areas and extremities.





Photodermatol Photoimmunol Photomed. 2011 Jun;27(3):147-51. doi: 10.1111/j.1600-0781.2011.00587.x.

The effect of 308 nm excimer laser on segmental vitiligo: a retrospective study of 80 patients with segmental vitiligo.

Do JE, Shin JY, Kim DY, Hann SK, Oh SH.


Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea Drs Woo and Hann's Skin Clinic, Seoul, Korea.


80 patients with segmental vitiligo were treated with Excimer Laser for a mean duration of 20 months.  23% showed grade 4 repigmentation, 4% showed grade 3 and 56% showed grade 1 and 2 repigmentation.  The degree of repigmentation correlated positively with treatment duration and cumulative UV dosage and correlated negatively with disease duration.  Additional treatments like surgical procedures need to be considered for a better response.





Dermatol Ther. 2010 May;23(3):305-7.

minocyclineOral minocycline in the treatment of vitiligo - A preliminary study.

Parsad D, Kanwar A.

Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.


In a study of 32 patients with progressive vitiligo, 29 patients had their disease arrested with minocycline 100mg daily for 4 weeks.  One of the factors involved in Vitiligo is oxidative stress and minocycline has anti-inflammatory, immunomodulatory and free-radical scavenging actions.  It has been shown that minocycline can rescue melanocytes from oxidative stress.




Australas J Dermatol. 2009 Aug;50(3):211-3.


Vitiligo-like depigmentation induced by imiquimod treatment of superficial basal cell carcinoma.


Sriprakash K, Godbolt A. 

Dermatology Department, Royal Brisbane Hospital, Brisbane, Queensland, Australia. 


A 61-year-old man was treated with imiquimod 5% cream for superficial basal cell carcinoma, five times per week for 13 weeks. This resulted in vitiligo-like depigmentation and poliosis in the area of treatment. This rare side-effect has been noted in previous case reports of imiquimod treatment for both genital warts and superficial basal cell carcinoma. 




Br J Dermatol. 2009 Jun 22. [Epub ahead of print]


Long-term results of 2-mm punch grafting in patients with vitiligo vulgaris and segmental vitiligo: effect of disease activity.


Fongers A, Wolkerstorfer A, Nieuweboer-Krobotova L, Krawczyk P, Tóth GG, van der Veen JP.

Netherlands Institute for Pigment Disorders, Meibergdreef 35, 1105 AZ Amsterdam, The Netherlands.


We studied 61 patients (25 male, 36 female) with vitiligo vulgaris and nine patients (all male) with segmental vitiligo who underwent 2-mm punch grafting more than 3 years ago. The main outcome measure was the degree of repigmentation of a single transplanted lesion as measured with a digital image analysis system with a mean follow-up of 5.2 years. Results: In patients with vitiligo vulgaris, 17 lesions (28%) showed excellent, 14 lesions (23%) showed good, 14 lesions (23%) showed fair and 16 lesions (26%) showed poor repigmentation. In patients with segmental vitiligo, seven of nine lesions (78%) showed excellent repigmentation. A cobblestone-like effect was observed in 19 of 70 patients (27%). Disease activity after punch grafting was reported in 94% of patients with poor repigmentation but in only 18% of patients with excellent repigmentation. Patients who reported disease activity after transplantation had a lower mean repigmentation than those who did not report disease activity (77% vs. 39%, P < 0.05). Conclusions Two-millimetre punch grafting in vitiligo is an effective surgical procedure with long-lasting effect. To prevent a cobblestone-like effect, we advise the use of smaller grafts (1-1.2 mm). Disease activity after grafting, localization and type of vitiligo, prior ultraviolet B treatment and a Koebnerized donor site influence the long-term outcome of punch grafting and should be taken into account in the selection of patients eligible for this treatment.




KM AlGhamdi. J Eur Acad Dermatol Venereol. 2009 Jun 1


A survey of vitiligo management among dermatologists

in Saudi Arabia


In this questionnaire based survey of 112 dermatologists in Saudi Arabia, active treatment of vitiligo was recommended by 96% in more than half of patients. 79% recommended treatment at non-visible sites. Repigmentation was

regarded as main treatment goal by 54%. Mid-potent topical steroids were widely prescribed for focal vitiligo . Use of tacrolimus and pimecrolimus was limited. The most common used phototherapy was‘narrowband ultraviolet B’. The use of oral psoralen plus UVA (PUVA) was limited (8% for generalized vitiligo in adults). Vitiligo surgery was advised mainly for segmental type (18% in adults and 5% in children). Depigmentation was the first option for universal vitiligo by 50% and 30% in adults and children,



Most dermatologists are enthusiastic about active treatment of vitiligo even in hidden sites. Overall, the most two common treatment modalities were topical steroids and NBUVB. Vitiligo surgery is underutilized. 




Int J Dermatol. 2009 Jan;48(1):86-90.


Efficacy and safety of tacrolimus cream 0.1% in the treatment of vitiligo.

Xu AE, Zhang DM, Wei XD, Huang B, Lu LJ.

Department of Dermatology, the Third Hospital of Hangzhou, Hangzhou, China.

30 patients with vitiligo were treated with tacrolimus ointment for at least 4 months. Twenty-five (83.3%) patients showed some repigmentation at the end of 4 months. Patients with vitiligo for more than 5 years also responded well to tacrolimus ointment. Repigmentation in active vitiligo was superior to that in stable vitiligo. 80% of patients with segmental vitiligo of the head and neck showed some response to tacrolimus, but there was no statistical significance between segmental and vulgaris vitiligo. The mean percentage of repigmentation on the head and neck was greater than that on the trunk and extremities. Four patients initially experienced burning on application. CONCLUSIONS: Topical tacrolimus ointment is an effective and well-tolerated alternative therapy for vitiligo especially involving the head and neck.




J Eur Acad Dermatol Venereol. 2009 Jun 2. 


Response of vitiligo to once- vs. twice-daily topical tacrolimus: a controlled prospective, randomized, observer-blinded trial.


Radakovic S, Breier-Maly J, Konschitzky R, Kittler H, Sator P, Hoenigsmann H, Tanew A.

Division of Special and Environmental Dermatology, Medical University of Vienna, Vienna, Austria.


Seventeen patients with generalized vitiligo were enrolled in this study. In each patient, two lesions were selected and randomized to treatment with either once- or twice-daily application of 0.1% tacrolimus for a total period of 6 months. In 10 patients, a third patch was left untreated to serve as a control. Results:  Fifteen patients with 40 target lesions completed the study. Twice-daily treatment induced excellent (> 75%) repigmentation in two lesions, moderate (> 25-50%) and poor (1-25%) repigmentation in four lesions each, and no response in five lesions. Once-daily treatment resulted in moderate repigmentation in two lesions and poor repigmentation in five lesions, whereas no effect was observed in the remaining eight lesions. One out of 10 control lesions developed moderate spontaneous repigmentation, the other nine remained unchanged. Besides the frequency of tacrolimus application, the treatment outcome was determined by the localization of the affected areas with the facial region showing the best response. Conclusions Tacrolimus ointment appears to be an effective treatment option for facial vitiligo. A guarded prognosis is advisable for vitiliginous lesions on other localizations. Treatment must be applied twice daily for optimum response.




J Cutan Med Surg. 2009 May-Jun;13(3):172-5.


Familial coexisting and colocalized psoriasis and vitiligo responding to alefacept.


Al-Mutairi N, Al-Doukhi A.


OBJECTIVE:To report two cases of the rare coexistence of psoriasis and vitiligo in a family. METHODS: Both patients were given alefacept 15 mg/kg weekly injections for 12 weeks. The patients were monitored both clinically and with all relevant laboratory investigations. These patients were then followed up once a month for 2 years. RESULTS:Treatment with alefacept led to complete clearance of vitiligo along with the expected improvement in psoriasis. In the 2-year follow-up, vitiligo did not recur, although psoriasis relapsed and was appropriately treated.CONCLUSION:Use of alefacept in vitiligo may turn out to be a possible novel off-label treatment option in vitiligo.




An Bras Dermatol. 2009 Jan-Feb;84(1):41-5.


Vitiligo and emotions

[Article in English, Portuguese]


Nogueira LS, Zancanaro PC, Azambuja RD.

Universidade Católica de Brasília, Brasília, DF, Brasil.


More than 75% of the patients have negative self-image on account of their vitiligo. The most frequently referred emotions were fear, specifically of expansion of the spots (71%), shame (57%), insecurity (55%), sadness (55%) and inhibition (53%). CONCLUSION:  Besides appropriate scientific guidance, vitiligo patients need emotional comfort. 





J Cosmet Dermatol. 2008 Sep;7(3):164-8.


Prevalence of pigmentary disorders and their impact on quality of life: a prospective cohort study.

Taylor A, Pawaskar M, Taylor SL, Balkrishnan R, Feldman SR.

Winston-Salem,  USA


This study aims to examine the prevalence of pigmentary disorders and their level of psychological and physical impact on patients. 


80% of the participants were diagnosed with one or more pigmentary disorders. 

47.3% of patients admitted of feeling self-conscious about their skin to some degree, 

21.8% felt others focused on their skin, 

32.7% felt unattractive because of their skin, 

32.7% put effort into hiding pigment changes, 

23.6% felt their skin affected their activities. 


Pigmentary disorders such as melasma, vitiligo, and lentigo pose significant negative impact on a person's health-related quality of life. 




Photodermatol Photoimmunol Photomed. 2008 Dec;24(6):314-7.


The perilesional skin in vitiligo: a colorimetric in vivo study of 25 patients.

Brazzelli V, Muzio F, Antoninetti M, Villani S, Donadini F, Altomare A, Borroni G.

 Pavia, Italy. 


Twenty-five patients affected by vitiligo were included. 

 Our results in vivo underline that the perilesional skin near the vitiligo spot is lighter than normal skin as far as 5 cm from the vitiligo spot.




Med Hypotheses. 2009 Feb 5.


Use of anti-tumor necrosis factor agents: A possible therapy for vitiligo.

Lv Y, Li Q, Wang L, Gao T.

Xijing Hospital, Xi'an, China.


Some vitiligo patients show higher lesion levels of tumor necrosis factor (TNF)-alpha. TNF-alpha is an important cytokine that exerts potent pro-inflammatory effects. There is growing evidence that TNF-alpha plays an important role in the cause of some autoimmunity diseases, including ankylosing spondylitis (AS). Treated with anti-TNF agents infliximab, with the improvement of AS, a patient's vitiligo lesions also faded out.  On the one hand, TNF-alpha destroys melanocytes. On the other hand, TNF-alpha inhibits melanocyte stem cells differentiation. Anti-TNF therapy may be an effective treatment for vitiligo.




Evaluation of safety and efficacy of topical prostaglandin E(2) in treatment of vitiligo.

Kapoor R, Phiske MM, Jerajani HR.

Br J Dermatol. 2008 Nov 11. [Epub ahead of print]


Prostaglandin E(2) (PGE(2)) has stimulant and immunomodulatory effects on melanocytes and regulates their proliferation. 

Methods: Fifty-six patients with vitiligo applied a translucent PGE(2)  gel twice daily for 6 months. 

Results:  Complete clearance occurred in eight of 40 patients, six of the eight having face lesions. Excellent response was seen in 22 of 40 patients. All neck, scalp and trunk lesions, 33% genital, 29% lip vitiligo, 100% segmental and 63% focal patches showed moderate to excellent response. Incidence of side-effects was 18%, mainly a transient burning sensation especially on the lips. 

Conclusions The efficacy and safety of topical PGE(2) make it a promising therapy for localized stable vitiligo.




Guideline for the diagnosis and management of vitiligo.

Gawkrodger DJ, Ormerod AD, Shaw L, Mauri-Sole I, Whitton ME, Watts MJ, Anstey AV, Ingham J, Young K; Therapy Guidelines and Audit Subcommittee, British Association of Dermatologists; Clinical Standards Department, Royal College of Physicians of London; Cochrane Skin Group; Vitiligo Society.

Br J Dermatol. 2008 Nov;159(5):1051-76.


A detailed and user-friendly guideline for the diagnosis and management of vitiligo in children and adults gives high quality clinical advice, based on the best available evidence. 


Treatments considered include: 


no treatment 

camouflage cosmetics and sunscreens

topical potent or highly potent corticosteroids

vitamin D analogues

topical calcineurin inhibitors

depigmentation with p-(benzyloxy)phenol


Systemic treatment: 



and other immunosuppressive agents



narrowband ultraviolet B (UVB)

psoralen with ultraviolet A (UVA)

khellin with UVA or UVB

combinations of topical preparations and various forms of UV


Surgical treatments:

 full-thickness and split skin grafting

mini (punch) grafts

autologous epidermal cell suspensions

autologous skin equivalents. 


Cognitive therapy 

Psychological treatments 





Camouflaging vitiligo with dihydroxyacetone.

Hsu S.

Dermatol Online J. 2008 Aug 15;14(8):23.


Dihydroxyacetone (DHA), the active ingredient in sunless tanning agents, can provide cosmetically acceptable camouflage for some 

vitiligo patients.




Treatment of vitiligo on difficult-to-treat sites using autologous noncultured cellular grafting.

Mulekar SV, Al Issa A, Al Eisa A. 

Dermatol Surg. 2009 Jan;35(1):66-71. Epub 2008 Dec 8


BACKGROUND:  Various surgical therapies have been developed to treat vitiligo. However, certain areas such as the fingers and toes, palms and soles, lips, eyelids, nipples and areolas, elbows and knees, and genitals are considered difficult-to-treat areas. 


INTRODUCTION:  Noncultured melanocyte-keratinocyte transplantation (MKT) is a recently developed surgical technique that does not require any special precautions to treat these anatomical sites. 


MATERIALS AND METHODS:  Forty patients vitiligo (both bilateral and unilateral) were treated using noncultured MKT, for "difficult-to-treat" sites at the National Center for Vitiligo and Psoriasis, Riyadh, Saudi Arabia, and were analyzed for response according to region. 


RESULTS: For bilateral vitiligo, more than 50% of patients treated for difficult sites showed more than 65% repigmentation of the treated areas. For unilateral vitiligo, all of the patients except for two treated for the eyelids showed more than 65% repigmentation of the treated area. 


CONCLUSIONS: noncultured MKT may be considered for treatment of difficult sites.






Narrowband ultraviolet B phototherapy and 308-nm excimer laser in the treatment of vitiligo: A review.

Nicolaidou E, Antoniou C, Stratigos A, Katsambas AD.

First Department of Dermatology, University of Athens School of Medicine, "Andreas Sygros" Hospital, Athens, Greece.

J Am Acad Dermatol. 2009 Jan 19


Phototherapy with narrowband ultraviolet B radiation and excimer laser are two treatment modalities that are used increasingly for the management of the disease with variable results. In this article, the authors review the efficacy, adverse effects, and possible mechanisms of action of narrowband ultraviolet B and excimer laser in the management of vitiligo. Available data concerning the follow-up of treated patients and some criteria for the selection of patients with a greater chance to respond satisfactorily to treatment are also presented.




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